Arterial hypertension in children and adolescents [Article in Serbian]

Abstract

Arterial hypertension in children and adolescents is defined as systolic and/or diastolic blood pressure (BP) that is, on repeated measurements ≥95th percentile for gender, age, and height. BP between the 90th and 95th percentile is termed „prehypertensive“ and is an indication for lifestyle modifications. Children older than 3 years old should have their BP measured at least once during every health care episode, while younger ones needs BP measurements at least once a year. The use of casual BP measurements, when performed carefully by trained personnel using calibrated and well-maintained devices, remains the primary screening tool to assess hypertension. Mercury and aneroid devices agree quite closely regarding the pressure that they detect, while oscillometry certainly differs from auscultatory methods, but comes closest to intra-arterial determinations. Ambulatory BP monitoring is now commonly used in diagnosis of pediatric hypertension, especially white coat hypertension, masked hypertension, BP load, and altered circadian BP rhythm. Overall, most childhood hypertension is secondary to an underlying disorder, which, in most cases, is renal disease. Primary hypertension becomes more common with increasing age, obesity and a sedentary lifestyle. Antihypertensive treatment requires a comprehensive approach, incorporating patient and family education, non pharmacologic measures, and if necessary antihypertensive medications, as well as monitoring for medication side effects and treatment response.